The efficacy of a dietary intervention programme to
control vitamin A deficiency through inexpensive, locally
available sources of ß-carotene was evaluated in 121 children
7-12 years old. The subjects were randomly divided into
experimental and control groups. A three-day food intake was
first recorded for each subject using a 24-hour recall method and
repeated at the end of the study on a randomly selected
subsample. The intervention period lasted one month, during which
carrots, papayas, coriander, and mint were offered daily as
sources of ß-carotene. There was no significant difference in
the dietary intakes of the groups before the study. After the
intervention period, the serum vitamin A values of the
experimental subjects were significantly higher than those of the
controls. These results indicate that consumption of small
amounts of inexpensive, readily available vegetable sources of
ß-carotene could help prevent and control vitamin A deficiency.
Nutrition education programmes are needed to encourage the use of
these foods for home consumption as well as in feeding programmes
for schoolchildren.

Vitamin A deficiency is a major public health nutrition
problem in India. It contributes to a sizeable proportion of
preventable blindness, particularly in young children. It is
estimated that 12,000 to 15,000 preschool children belonging to
poor income groups become blind as a result of vitamin A
deficiency [1]. The major cause is inadequate dietary intake of
vitamin A [2]. Hence the most rational method to prevent and
control the disorder is to increase the dietary intake of the
vitamin. Preformed vitamin A is present only in foods of animal
origin, which are expensive and beyond the reach of a large
proportion of the population. On the other hand, rich sources of
ß-carotene such as carrots (Daucus carota), green leafy
vegetables, and yellow fruits such as papayas (Carica papaya) and
mangos (Mangifera indica) are inexpensive and can totally meet
the requirements of children belonging to low socio-economic
groups. Unfortunately, these items do not find their way into the
diets of this most vulnerable section of the population.

Implementing the use of only one source of ß-carotene in
daily diets is impractical, as variety in the diet is essential.
Therefore, a number of sources should be used in a dietary
intervention programme to control vitamin A deficiency.

This study was designed to evaluate the efficacy of a dietary
intervention programme to control vitamin A deficiency in
7-12-year-old children through rich but cheap, easily available,
and varied local sources of ß-carotene.

The study was conducted in an orphanage in Delhi, India. All
121 inmates between 7 and 12 years of age made up the sample. The
sample was randomly divided into two groups, experimental and
control, that were matched with respect to sex. The investigation
was conducted in three phases:

1. Collection of dietary data

A dietary survey was conducted with the help of an interview
schedule using the 24-hour-recall method. Food intake was
recorded for three days (two weekdays and one holiday, including
Sunday). The diets were analysed for their energy, protein, fat,
ß-carotene, and retinal content using food composition tables
[3]. To check the authenticity of the data, the survey was
repeated at the end of the study on a randomly selected subsample
of 40 children.

2. Dietary intervention

Four rich sources of ß-carotenecarrots, papayas,
coriander (Coriandrum sativum), and mint (Mentha
viridis)were used for the intervention, which lasted for
one month. These foodstuffs were selected as they were cheap and
available in abundance during the time of the investigation. The
use of four sources of 9-carotene ensured better acceptability.

The experimental group was given raw carrots five times a
week, and papaya and coriander-mint chutney twice a week. Since
the foodstuffs were not analysed for their é-carotene content,
they were incorporated in sufficient amounts to provide more than
the recommended allowance for the vitamin. Since the children
belonged to two age groups whose recommended dietary allowances
are not the same, they were given different amounts of the
supplements (table 1).

TABLE 1. Supplementary foods

Group and
age (years)

Food
supplement

Times/
week

Amount
(g)

ß-carotene
(µg/day)

Experimental

7-9

carrots

5

125

2,362

papaya

2

150

coriander-mint chutneya

2

25

average

2,313

10-12

carrots

5

175

3,300

papaya

2

300

coriander-mint chutneya

2

25

average

3,268

Control

7-12

radishes

7

100

3

a. Coriander 15 g, mint 10 g, lemon juice 30 g.

The control group was given a supplement of radishes, which
provide almost no ß-carotene.

3. Evaluations and collection of blood samples

The difference between the serum vitamin A levels of the two
groups after the dietary intervention was used as an index for
assessing the efficacy of the intervention. Serum vitamin A
levels were estimated with a Farrand spectrofluorometer, model MK1
(Farrand Optical Co., Valhalla, N.Y., USA), using the
microspectrofluorometric method of Selvaraj and Susheela [4].

One blood sample was drawn per child. (It took three
consecutive days to collect all the samples.) About 5 ml of
venous blood was taken and let stand for two hours. It was then
centrifuged and the serum was separated. The serum samples were
stored in a freezing chamber of a refrigerator, and all were
analysed within one week of collection.

The average daily intake of foods is presented in table 2. The
children were consuming a vegetarian diet that was grossly
deficient in cereals, green leafy vegetables, and milk and milk
products, and moderately deficient in sugar and fat. Despite the
low intake of milk and the absence of meat and eggs, the diet was
qualitatively adequate with respect to proteins, as the pulse and
cereal protein ratio was high (1:1).

TABLE 2. Average daily food intake (grams)

Food group

Average consumption

Recommended
allowancea

Cereals

184 ± 30

285

Pulses

77 ± 18

65

Milk and milk products

38 ± 21

250

Green leafy vegetables

4 ± 3

85

Roots, tubers, and other
vegetables

102 ± 50

62

Fruits

63 ± 50

50

Fat

17 ± 4.5

30

Sugar

24 ± 12

50

N = 121.
a. Indian Council of Medical Research, 1978.

The average intake of significant nutrients is shown in table
3. The diet was inadequate with respect to energy, fat, and
vitamin A, but was adequate in protein.

TABLE 3. Mean daily intake of nutrients prior to
supplementation

Intake

Calories

1,264±127

Protein (g)

40±6

Fat (g)

25.6±5

Total vitamin A equivalents (µg retinol) 256±63
N= 121.

The diet survey conducted at the end of the supplementation
period revealed no deviation from the pattern observed in the
initial survey other than the supplement. There were no
appreciable differences between the dietary intakes of the
control and the experimental groups, or between the sexes.

Serum vitamin A levels

The guidelines of the Interdepartmental Committee on Nutrition
for National Defense (ICNND) for the interpretation of serum
vitamin A levels were used for the investigation. Of the total
sample of 121 children, the serum vitamin A levels of 114 could
be estimated (table 4).

TABLE 4. Mean serum vitamin A levels (µg/dl)

Group

N

Level

Control

54

15.5±2.5

Experimental

60

25.1 ±2.9

t = 2.02 ( p < .05).

In the control group, 49 subjects (91%) had low levels of
serum vitamin A, and 5 (9%) had acceptable levels. The mean level
of the control group was 15.5±2.53 µg/dl. Despite the low serum
levels, no clinical manifestations of vitamin A deficiency were
seen among the children. Similarly, other investigators have
found no association between low or deficient serum levels and
clinical signs of vitamin A deficiency [5].

The children in the experimental group, who had received about
2,313 µg (7-9-year-olds) or 3,268 µg (10-12-year-olds) of
ß-carotene per day for one month, showed much higher serum
values than the control subjects. Of the 60 subjects, the serum
values were acceptable in 57 (95%) and low in 3 (5%) (range
18.04-27.33 µg /dl).

There was no appreciable difference in the dietary intakes of
the experimental and control groups. However, the vitamin A
intake of the experimental group increased significantly with
0-carotene supplementation. Estimations after the intervention
indicated that, while the majority of the control subjects (91%)
had low serum vitamin A levels, the majority of the experimental
subjects (95%) had acceptable levels. There was a highly
significant difference (p=.005) in the serum levels of the two
groups. We concluded that the levels in the experimental subjects
were higher solely due to the additional ß-carotene in their
diet. Similar observations have been reported in preschool
children [6-8].

The investigation shows that encouraging the consumption of
rich but cheap sources of ß-carotene without introducing any
other change in the dietary pattern can go a long way toward
controlling and preventing vitamin A deficiency. It is an
inexpensive and feasible way to ensure an adequate dietary intake
of ß-carotene and does not involve any difficult cooking. Thus
the workload of the people who would be implementing the method
would not be unduly increased. The use of four different sources
of ß-carotene would contribute to variety in the diets and
consequently improve acceptance by the population at large.

As an outgrowth of our study, we recommend establishing
rigorous nutrition education programmes to encourage the
consumption of carotene-rich foods and setting up kitchen gardens
to grow such foods. Such measures will need to be adopted for the
application of the results of this investigation.

Our results may find application at the national level also.
India is conducting a number of continuing feeding programmes for
schoolchildren. Their major emphasis is on providing additional
calories and protein, but ß-carotene could also be provided
without much difficulty. The national prophylaxis programme
covers only children 1-5 years old and does not ensure life-long
protection against vitamin A deficiency. However, it is essential
to maintain an adequate vitamin A status at all stages of life.
It has been suggested that the vitamin is involved in the immune
mechanism; therefore, maintaining adequate vitamin A levels is
imperative during childhood, when there is a high prevalence of
infections. Furthermore. children with inadequate vitamin A
reserves are likely to have a progressive worsening of status.
This can be of great significance in women, particularly during
the reproductive years, as maternal vitamin A status determines
foetal stores.